For those of you unfamiliar with who or what the thyroid even is, it is a butterfly shaped gland that sits within your neck. Despite its dainty appearance, it is a small and mighty gland responsible for nearly every process in the body. When it is sluggish, the whole body can become sluggish, and when it is quick, the whole body is certainly quick!
When I was a student intern, I was so surprised to find out how rampant thyroid disease is and the number of people who are on Synthroid/ Levothyroxine/ synthetic T4. Especially when they come in and it’s not their primary concern of why they’re seeing me.
When I realized how pervasive it really was, I decided to dig in and research just how many people are plagued with thyroid disease, typically an under-active thyroid (hypothyroidism). Without recalling specific numbers in the general population, I found the more alarming number to be that synthetic T4 was in the top 2 of commonly prescribed drugs. Top 2! Only just behind statins (cholesterol lowering meds).
Just the other day I had a prospective patient call to chat about what it would be like to work with me. (PS we all do that here; since we’re out of network we want to give you the opportunity to hear what it would be like to work with us!) She told me that she is pretty much heathy except for some “thyroid stuff.” I’ve never sat in a PCP or endocrinologist office to receive such a diagnosis to know how that conversation goes, but given the flippancy of the statement, I can only assume that is how it is managed when they speak to a patient.
Maybe this is because patients aren’t really given many options on how to manage their thyroid to either prevent going on meds or prevent the need for increased thyroid hormone. The truth is, there’s a lot of conflicting information about there in terms of diagnosis. The diagnostic criteria for hypothyroidism is a Thyroid Stimulating Hormone (TSH) of 4.50 or greater (typically seen with a low T4 thyroid hormone, but is not diagnostic); however, those individuals with TSH’s between 4.50-7 or 10 with a normal T4 are deemed subclinical hypothyroid. It is in these cases that about 46% of people will spontaneously resolve and return to a normal thyroid state.
Yikes. This is concerning because I have patients in my practice who don’t even know what their TSH was when they were prescribed thyroid hormone!
To understand why this is the case, it’s important to know that when we have our blood drawn to measure TSH (the hormone from the brain that yells or softly speaks to the thyroid gland itself to produce thyroid hormone) we’re only looking at a snapshot in time. Much like all of our other hormones cycle throughout the day or month, so too does TSH.
There are a lot of reasons why somebody’s TSH could be transiently elevated and if I am the physician ordering the thyroid labs on a patient for the first time who is showing elevated TSH, there are so many interventions to employ that it actually makes me a little upset when other doctors shrug their shoulders and pull out the prescription pad so quickly. Or the reverse is true, somebody is expressing overt symptoms of a sluggish thyroid but their labs have yet evidence hypothyroidism.
If you’re somebody who has hypothyroidism and are on meds but feel little to no difference on them, consider that your physician is prescribing based on lab values rather than the based on you, the patient. A lot of thyroid issues can stem in the gut, due to poor absorption and assimilation of necessary nutrients. The flip side to this is whether or not the GI can even absorb the thyroid hormone you’re being given. You see, T4 (the form of thyroid hormone that is found in Synthroid, levothyroxine, etc) is inactive and must be converted into T3, the active hormone. If your body has poor conversion ability, you can take all of the T4 you want and lower your TSH to “normal” levels, but none of that matters if your body isn’t responding properly, right?
Considering mineral status in hypothyroid patients I really important as well as checking other hormones, especially in cycling women.
If you feel like your thyroid medical care is falling short, it might be time to consider an adjunctive provider who can look at your case from a different lens.
References:
Papaleontiou M, Cappola AR. Thyroid-Stimulating Hormone in the Evaluation of Subclinical Hypothyroidism. JAMA. 2016 Oct 18;316(15):1592-1593. doi: 10.1001/jama.2016.9534. PMID: 27755618; PMCID: PMC5450818.
